Humana

Virginia Medicaid Pharmacy Director

Humana

full-time

Posted on:

Location Type: Remote

Location: Virginia • United States

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Salary

💰 $138,900 - $191,000 per year

Job Level

Lead

About the role

  • The Clinical Pharmacist Lead monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders.
  • Utilizes broad understanding of managed care and PBM knowledge to develop, and/or implement strategies and programs to mitigate cost trend and improve health outcomes.
  • The Clinical Pharmacist Lead works on problems of diverse scope and complexity ranging from moderate to substantial.
  • The Pharmacy Director, internally known as a Clinical Pharmacy Lead, plans, directs, and monitors all financial, operational, professional, and clinical activities for the purposes of pharmacy program development for our Medicaid and Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Virginia health plan.
  • The individual leverages a broad understanding of managed care and pharmacy benefit management (PBM) to develop and implement strategies and programs that mitigate cost trends and improve health outcomes.
  • They ensure the pharmacy department provides optimal pharmaceutical services that meet all legal, accreditation, and certification requirements.
  • This position will coordinate day-to-day pharmacy operations directly with the plan Chief Executive Officer and Chief Medical Officer.
  • Keeps current with State and Federal regulations regarding the practice of Pharmacy and implements changes as necessary to maintain compliance supporting both the business and public relations strategies.
  • Develops corporate communications to be shared with senior leadership.
  • Supports trend management by conducting analysis of drug spend, utilization, and/or approval scenarios.
  • Advises executives to develop functional strategies (often segment specific) on matters of significance.
  • Exercises independent judgment and decision making on complex issues regarding job duties and related tasks.
  • Works under minimal supervision, using independent judgment requiring analysis of variable factors and determining the best course of action.
  • Facilitates and consults across teams and managing projects working collaboratively and communicating with staff in different positions and all levels of management positions.
  • Manages the Virginia health plan relationship with our internal PBM, Humana Pharmacy Solutions ensuring compliance with programmatic requirements, such as claims processing, prior authorization, formulary management and clinical programming.
  • Represents Humana at all Pharmacy Medicaid meetings including those with the Virginia Department of Medical Assistance Services (DMAS).
  • Develops, executes and manages National Medicaid Pharmacy programs as needed.

Requirements

  • Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD)
  • Must reside and have an active Pharmacist license with the Board of Pharmacy in Virginia.
  • Minimum of ten plus years of Pharmacy Experience with at least three years’ experience in managed care and/or PBM operations
  • Ability to travel 10% of time
  • Successful track record in facilitating and consulting across teams and managing projects
  • Thrives in a fast paced, multi-project work environment while still ensuring attention to detail
  • Excellent communication skills, both oral and written
  • Proficiency in Microsoft Word, Excel, & PowerPoint
  • Expertise in working collaboratively and communicating with staff in different positions and all levels of management position
  • Preference to candidates who currently live in or in the vicinity of Richmond, VA.
Benefits
  • medical, dental and vision benefits
  • 401(k) retirement savings plan
  • time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
  • short-term and long-term disability
  • life insurance
  • many other opportunities
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
PharmacyPharmacy Benefit Management (PBM)Managed CareDrug DevelopmentClinical ProgrammingFormulary ManagementClaims ProcessingPrior AuthorizationPharmaceutical ServicesTrend Management
Soft Skills
CommunicationProject ManagementIndependent JudgmentDecision MakingCollaborationAttention to DetailFacilitationConsultingProblem SolvingLeadership
Certifications
Pharmacist LicenseBachelor’s Degree in PharmacyDoctor of Pharmacy (PharmD)